H.H.C. Group Launches New Podcast Series Exploring Healthcare Cost Containment and Payment Disputes

Healthcare costs continue to rise while health plans, self-funded employers and other payors face increasingly complicated claims, payment and compliance challenges.

To help healthcare stakeholders better understand these issues, H.H.C. Group has launched a new podcast series, featuring practical perspectives on healthcare cost containment, claims management and payment integrity.

The first two episodes examine a fundamental question facing employers and payors and a rapidly evolving process for resolving certain out-of-network payment disputes.

Employers are continually presented with new programs, technologies, discount arrangements and vendors promising to reduce healthcare spending. Yet healthcare costs continue to climb.

In the first episode, "Real People Delivering Value" H.H.C. Group examines why the growing number of available healthcare solutions has not necessarily translated into lower costs.

One reason is the difference between managing healthcare costs and actively containing them.

Cost management frequently focuses on responding to rising expenses through renewal negotiations, trend analysis and the implementation of new programs. True cost containment goes deeper by identifying and preventing unnecessary spending at the claim level.

Every day, healthcare claims may include billing inaccuracies, coding issues, incorrect diagnosis-related group assignments and charges that warrant further review or negotiation. When these issues go undetected, excess payments can become part of an employer's claims experience and contribute to future cost increases.

The episode explores how claim-level oversight and payment-integrity strategies can help organizations address these underlying cost drivers. These strategies may include:

• Attorney-led claims negotiations
• Medical bill review
• DRG validation
• Claims auditing and analysis
• Identification and prevention of overpayments
• Review of high-cost and out-of-network claims

Adding more programs or vendors does not automatically produce savings. Effective cost containment requires organizations to examine where their healthcare dollars are going, determine whether claims are being paid accurately and act on opportunities to prevent avoidable spending.

The episode encourages employers and their healthcare partners to consider a critical question: Is the organization primarily responding to annual cost increases, or is it identifying and addressing unnecessary expenses before they become embedded in its healthcare spend?

Healthcare payment disputes can be costly, time-consuming and operationally challenging. When a health plan and an out-of-network provider cannot agree on payment for certain services covered by the No Surprises Act, the Federal Independent Dispute Resolution process may provide a mechanism for resolving the disagreement without traditional litigation.

In the second episode, "Independent Dispute Resolution: A Guide for Health Plans, Providers and Healthcare Payors," H.H.C. Group provides an overview of the Federal IDR process and explains why preparation should begin well before a formal dispute is initiated.

The episode walks listeners through key stages of the process, including:

• The required open negotiation period
• Initiating a Federal IDR dispute
• Selecting a certified IDR entity
• Submitting payment offers and supporting information
• The IDR entity's payment determination
• Payment requirements following a decision

Listeners will also learn about the Qualifying Payment Amount, commonly known as the QPA, and the role it may play in an IDR proceeding.

The discussion highlights important considerations for health plans, TPAs, self-funded employers, stop-loss organizations and other healthcare payors. These include determining whether a claim is eligible for Federal IDR, identifying whether a state process applies, tracking filing deadlines, organizing supporting documentation and properly batching disputes.

The episode also discusses how negotiation, medical bill review, reference-based pricing and PPO network repricing may help organizations evaluate claims and potentially resolve disagreements before they advance to formal IDR.

With millions of disputes submitted since the Federal IDR process launched in 2022—and additional operational changes taking effect in 2026—healthcare stakeholders need deliberate processes for managing eligibility, documentation, deadlines and payment strategy.

Together, H.H.C. Group's first two podcast episodes demonstrate the importance of actively examining healthcare claims and payment practices.

One explores how unnecessary payments contribute to rising healthcare costs. The other examines what happens when providers and payors cannot agree on the appropriate payment for certain out-of-network services.

Both conversations reinforce the value of careful claim review, informed negotiation, payment accuracy and preparation.

For more than 30 years, H.H.C. Group has helped healthcare stakeholders address medical claim costs through claims negotiation, medical bill review, DRG validation, reference-based pricing, PPO network repricing, independent medical review and dispute-resolution services.

www.hhcgroup.com/podcasts.

To learn more about H.H.C. Group's healthcare cost-containment and claims-management services, call 800-836-8681, visit www.hhcgroup.com or email info@hhcgroup.com.